Clinically, small vascular malformations (SVMs, including other small vascular lesions) on the vocal folds are a common problem that disturbs the voice. This disease is especially troublesome for the professional voice user. It may have a high risk of vocal fold hemorrhage and scarring, thereby permanently altering voice. Currently, this problem is treated with endoscopic removal of the lesions with the use of a CO2 laser or other "cold" microsurgeries. However, those treatments are far from being satisfactory because all of those procedures require an incision through a normal epithelium and disruption of the normal Reinker's layer. Such intervention can often result in scarring and poor voice restoration. The pulsed dye laser (PDL) has been successfully used for treatment of microvascular lesions in cutaneous tissue, through its high selectivity for destroying targeted vasculature while sparing normal tissue. Our previous studies have shown the efficacy and safety of PDL as an alternative to routine surgeries for treatment of laryngeal papilloma. In this proposed study, our hypothesis is that microvascular targeting (MVT) therapy with PDL is safe and effective for treatment of SVMs on vocal folds. We will test this hypothesis with following specific aims: (1) to further optimize PDL parameters in the cheek pouches of a hamster model; (2) to compare the treatment selectivity and safety between PDL and CO2 laser surgery in the same model; and (3) to determine whether PDL will produce better and quicker voice improvement while effectively clearing the lesions than the CO2 laser, in 20 patients with vocal fold SVMs. This is the first study to use laser MVT technique to treat vocal fold SVMs. This new and less invasive treatment, if success in this study, will provide an ideal and excellent alternative to current surgical approaches for treatment of these diseases on the vocal fold. It would be safe and convenient enough for an out-patient treatment, without requiring a general anesthesia. [unreadable] [unreadable]